Individual
JESSICA ELAINE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
33 LONO AVE STE 250, KAHULUI, HI 96732-1634
(808) 500-3439
Mailing address
33 LONO AVE STE 250, KAHULUI, HI 96732-1634
(808) 500-3439
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
19423
SC
363L00000X
Nurse Practitioner
2240
HI
363LF0000X
Family Nurse Practitioner
Primary
2240
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812778
—
HI
05
—
NP3164
—
SC
Enumeration date
04/10/2015
Last updated
04/30/2025
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